摆位误差对前列腺癌靶区和危及器官剂量分布的影响研究

doi:10.3760/cma.j.issn.1004-4221.2019.01.008

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摘要目的研究前列腺癌放疗中摆位误差对靶区和OAR剂量的影响。方法随机选取近1年内治疗的前列腺癌患者12例,每位患者在治疗过程中行6~10次CBCT获取摆位误差。在TPS中用带入平均值模拟(Plan_A)和带入分次CBCT误差值合成计划(Plan_F)两种方式通过移动等中心位置,在不改变射野分布、权重及计划跳数的情况下计算剂量分布。对比分析模拟计划和原计划(Plan_O)的剂量差别。结果 CTVD95的Plan_A与Plan_O不同(P=0.008),Plan_F与Plan_O相近。PTVD95的Plan_F与Plan_O、Plan_A与Plan_O均不同(P=0.004、0.041)。直肠V60、Dmax,左股骨V20、Dmax,右股骨Dmax的Plan_F与Plan_O不同(P=0.026、0.015、0.041、0.049、0.003);Plan_A和Plan_O只显示左股骨Dmax不同(P=0.045)。患者头脚方向上的误差与直肠V40、V50、V60变化相关(r=-0.785、-0.887、-0.833),与PTV D95变化相关(r=-0.682),前后方向上的移动与膀胱V20、V30、V40、V50、V60变化相关(r=-0.945、-0.823、-0.853、-0.818、-0.774)。再行计划中所有正常组织的评价指标均能满足临床要求,但是靶区处方剂量体积均有不同程度的亏量,且Plan_F的亏量均大于Plan_A。结论取平均值带入TPS的模拟方式低估了日常摆位误差对于剂量分布的影响。摆位误差对于靶区剂量分布的影响大于正常组织器官。y轴向误差更容易引起直肠和PTV的剂量变化,而z轴向的误差更容易引起膀胱的剂量变化。

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关键词 ：前列腺肿瘤/放射疗法, 摆位误差, 剂量分布

Abstract： Objective To evaluate the effect of setup errors upon the target area and the organs at risk (OAR) during radiotherapy for prostate cancer. Methods Twelve prostate cancer patients receiving treatment in the recent 1 year were randomly recruited in this study. The position of each patient was verified by using cone beam CT (CBCT) for 6-10 times during the treatment. In treatment planning system (TPS), the isocenter position was moved along the setup errors with averaging error value (Plan_A) and each CBCT value (Plan_F). The dose distribution was recalculated without changing the beam setting, weight factors and monitor units (MUs). The dose difference was statistically compared between the simulation and original plans (Plan_O). Results For clinical target volume (CTV) D95, there was a significant difference between Plan_A and Plan_O (P=0.008), whereas no significant difference was observed between Plan_F and Plan_O. There were significant differences between Plan_F and Plan_O, Plan_A and Plan_O (P=0.004, and 0.041) for the planned target volume (PTV) D95.For OAR, rectal V60, Dmax, left femoral V20, Dmax and right femoral Dmax significantly differed between Plan_F and Plan_O (P=0.026,0.015,0.041,0.049,0.003).However, only left femoral Dmax significantly differed between Plan_A and Plan_O (P=0.045). The movement in the superior-inferior (SI) direction was significantly correlated with the changes in the rectal V40,V50 and V60 and PTV D95(r=-0.785,-0.887,-0.833,0.682).The movement in the anterior-posterior (AP) direction was significantly associated with the variations in the bladder V20,V30,V40,V50 and V60(r=-0.945,-0.823,-0.853,-0.818,-0.774).The evaluation indexes of all normal tissues in the re-plan could meet the clinical requirements. However, the volume of target prescription volume had different levels of deficit, and the deficit of Plan_F was greater than that of Plan_A. Conclusions The simulation results of averaging into the TPS underestimates the effect of daily setup errors on the dose distribution. The effect of setup errors on the dose distribution in target area is greater than that of normal tissues. Y-direction errors are more likely to cause the variations of the rectal and PTV dose, and the errors in the z-direction are inclined to cause the changes in the bladder dose.

Key words： Prostate neoplasm/radiotherapy Setup error Dose distribution

收稿日期: 2017-09-27

通讯作者: 符贵山,Email:guishan11@163.com

引用本文:

覃仕瑞,张寅,李红菊等. 摆位误差对前列腺癌靶区和危及器官剂量分布的影响研究[J]. 中华放射肿瘤学杂志, 2019, 28(1): 37-40.

Qin Shirui,Zhang Yin,Li Hongjv et al. Effects of the setup errors on dose distribution of target area and organs at risk for prostate cancer[J]. Chinese Journal of Radiation Oncology, 2019, 28(1): 37-40.

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[1] Evans-Axelsson S,Timmermand OV,Bjartell A,et al. Radioimmunotherapy for prostate cancer-current status and future possibilities[J].Semin Nucl Med,2016,46(2):165-179.
[2] Youlden DR,Baade PD,Krnjacki LJ.International epidemiology of prostate cancer:geographical distribution and secular trends[J].Mole Nutrit Food Res,2009,53(2):171-184.
[3] 韩苏军,张思维,陈万青,等.中国前列腺癌发病现状和流行趋势分析[J].临床肿瘤学杂志,2013,18(4):330-334. DOI:10.3969/j.issn.1009-0460.2013.04.009.
Han SJ,Zhang SW,Chen WQ,et al. Analysis of the status and trends of prostate cancer incidence in China[J].Chin Clin Oncol,2013,18(4):330-334.DOI:10.3969/j.issn.1009-0460.2013.04.009.
[4] 曹德宏,柳良仁,魏强, 等.前列腺癌的治疗研究进展[J].华西医学,2017,(2):277-281.
Cao DH,Liu LR,Wei Q,et al. Advances in the treatment of prostate cancer[J].West Chin Med J,2017,(2):277-281.
[5] Tilikidis A,Sorcini B.Clinical application of image-guided radiotherapy, IGRT (on the Varian OBI platform)[J].Cancer Radiother,2006,10(5):252-257.
[6] Staffurth JN,Button MR.Clinical application of image-guided radiotherapy in bladder and prostate cancer.[J].Clin Oncol,2010,22(8):698-706.
[7] Ploeger L,van Herk M,Lebesque JV,et al.3-D portal image analysis in clinical practice:an evaluation of 2-D and 3-D analysis techniques as applied to 30 prostate cancer patients[J].Int J Radiat Oncol Biol Phys, 2000,46(5):1281-1290.
[8] 刘跃平,金晶,王维虎, 等.前列腺癌放疗的摆位误差分析[J].临床肿瘤学杂志,2014,(10):910-912.
Liu YP,Jin J,Wang WH,et al. Analysis of set-up errors during radiotherapy of prostate cancer[J].Chin Clin Oncol, 2014,(10):910-912.
[9] 李明,林海磊,修霞, 等.膀胱直肠管理对前列腺癌靶区及OAR剂量影响[J].中华放射肿瘤学杂志,2015,(6):644-648. DOI:10.3760/cma.j.issn.1004-4221.2015.06.009.
Li M,Lin HL,Xiu X,et al. Effects of bladder and rectum management on dose distributions of target and organs at risk in intensity-modulated radiotherapy for prostate cancer[J].Chin J Radiat Oncol,2015,(6):644-648.DOI:10.3760/cma.j.issn.1004-4221.2015.06.009.
[10] 王鑫,胡超苏,应红梅, 等.摆位系统误差对鼻咽癌放疗剂量分布的影响[J].中国癌症杂志,2008,18(8):620-625. DOI:10.3969/j.issn.1007-3639.2008.08.013.
Wang X,Hu CS,Ying HM,et al. Systematic setup errors for intensity modulated radiation therapy in the nasopharyngeal carcinoma:effect on dose distribution[J].Chin Oncol,2008,18(8):620-625.DOI:10.3969/j.issn.1007-3639.2008.08.013.
[11] 张修龙,李兆斌,黄国锋, 等.乳腺癌保乳术后调强放疗摆位误差的剂量学研究[J].现代肿瘤医学,2009,17(8):1555-1556. DOI:10.3969/j.issn.1672-4992.2009.08.061.
Zhang XL,Li ZB,Huang GF,et al. Dosimetry study of setup errors in intensity modulated radiation therapy for breast cancer conserving surgery[J].J Mod Oncol,2009,17(8):1555-1556.DOI:10.3969/j.issn.1672-4992.2009.08.061.
[12] 文婷,李志强,张晋建, 等.螺旋断层放疗自适应技术的初步应用[J].中国医学物理学杂志,2012,29(4):3515-3518. DOI:10.3969/j.issn.1005-202X.2012.04.013.
Wen T,Li ZQ,Zhang JJ,et al. A Preliminary Application of the Helical Tomotherapy Adaptive System[J]. Chin J Med Phys,2012,29(4):3515-3518.DOI:10.3969/j.issn.1005-202X.2012.04.013.
[13] 井笛.摆位误差对鼻咽癌患者脑干剂量的影响[D].中南大学,2014.
Jing D.Effects of the setup error on the dose distribution of brainstem for nasopharyngeal carcinoma[D].Central South University,2014.
[14] 高超,王澜,迟子锋, 等.食管癌三维适形放疗中摆位误差对剂量学影响的研究[J].中华放射肿瘤学杂志,2009,18(4):270-273. DOI:10.3760/cma.j.issn.1004-4221.2009.04.270.
Gao C,Wang L,Chi ZF,et al. Impact of setup errors on dose distribution of three dimensional conformal radiotherapy for patients with esophageal carcinoma[J].Chin J Radiat Oncol,2009,18(4):270-273.DOI:10.3760/cma.j.issn.1004-4221.2009.04.270.
[15] Ariyaratne,Hemal,Chesham, et al. Image-guided radiotherapy for prostate cancer with cone beam CT:dosimetric effects of imaging frequency and PTV margin[J].Radiother Oncol,2016,121(1):103-108.
[16] 吴润叶.千伏级锥形束断层扫描离线校位在鼻咽癌调强适形放疗中的初步应用[D].北京协和医学院,2009.
Wu RY.Preliminary application of kilo-volt cone-beam computed tomography to off-line correction of set-up errors in intensity-modulated radiotherapy of nasopharyngeal carcinoma[D].Peking union medical college,2009.